Pathology tests and health insurance

Medicare and private health insurance both provide some cover for blood tests and pathology tests.

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If your doctor has ordered you to undergo a pathology or blood test, you might be wondering how much this procedure is going to cost. You might also be confused as to whether some or all of the cost will be covered by Medicare or your private health insurance fund. Let’s take a look at how blood tests work and whether you will need to pay for them out of your own pocket.

Does private health insurance cover blood tests?

Private health insurance can sometimes cover the cost of blood tests depending on whether you receive treatment as an inpatient or outpatient. If you undergo a pathology test while admitted to hospital as an inpatient, hospital cover from your private health fund should cover this expense. If you undergo a pathology or blood test as an outpatient, such as through your GP, you probably won’t be covered. Outpatient blood tests are typically covered by Medicare (unless you’re an overseas visitor, in which case your private health insurance may provide some cover).

Keep in mind that even if cover for the cost of a blood test is provided by Medicare or private health insurance, there may be some out-of-pocket costs. This occurs if the pathology costs are greater than the Medicare rebate and the amount covered by your private health fund.

Is blood work covered by Medicare?

The Australian Government provides funding for a wide range of pathology tests through the Medicare Benefits Schedule (MBS). However, you will only be eligible for a rebate on a blood test listed on the MBS if the following conditions are met:

  • The pathology test must be requested by your treating practitioner (the practitioner must be registered with Medicare)
  • There must be a medical reason for the blood test
  • Your blood sample must be sent to a pathology laboratory that is approved by Medicare
  • The pathology test has been supervised and has undergone quality assurance in line with Medicare accreditation rules

As an example, if a blood test is requested for insurance purposes rather than for a medical reason, it will not be eligible for a rebate.

It's also worth pointing out that there are sometimes limits on the number of times you can receive a rebate for the same blood test in a 12-month period. More details about any limits that apply can be found in the MBS.

Common questions about blood and pathology tests

Below are some of the common questions we're asked about blood work and other pathology tests.

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